What Is Telogen Effluvium

Introduction

Telogen effluvium is a form of non-scarring alopecia which can be identified by excessive shedding of hair. It occurs when a significant number of hair follicles prematurely enter the telogen, or resting, phase of the hair growth cycle. This shift can be triggered by various factors, such as illness, surgery, childbirth, rapid weight loss, certain medications, nutritional deficiencies, and hormonal imbalances.¹

Typically, hair grows in cycles, with each follicle going through a growth phase (anagen), a transitional phase (catagen), and finally, the resting phase (telogen) before shedding and regenerating. In telogen effluvium, the majority of affected hair follicles enter the telogen phase simultaneously, leading to noticeable hair thinning or loss within a few months after the triggering event.²

Telogen effluvium is often temporary, and hair usually regrows once the underlying cause is addressed or resolved. It's essential to consult a healthcare professional or dermatologist to identify the specific trigger and develop an appropriate treatment plan to support healthy hair regrowth.¹

Hair growth cycle

The hair growth cycle is a complex and continuous process that regulates the growth and shedding of hair on our bodies. At any time, 10% of the total scalp hair is in the telogen phase.² Hair loss can be managed by reducing the percentage of hair follicles in the telogen phase. Understanding this cycle is essential for maintaining healthy hair and addressing issues such as hair loss.³

Causes of telogen effluvium

There are five mechanisms proposed by Headington (Reference) due to which hair may shed in telogen effluvium:

1. Immediate anagen release 

Follicles leave the anagen phase and enter the telogen phase prematurely.

2. Delayed anagen release

The anagen phase is prolonged which results in heavy shedding of hair in the telogen phase.

3. Short anagen syndrome 

This occurs due to idiopathic shortening of the anagen phase.

4. Immediate telogen release 

This occurs when the telogen phase is shortened, which results in the release of club hair.

5. Delayed telogen release 

This occurs when the telogen phase is prolonged and the transition to anagen phase is delayed.²

Telogen effluvium can be related to:

1. Drugs or medications 

Intake of anticoagulants, oral contraceptive pills, antidepressants, and beta-blockers increases the risk of developing telogen effluvium.²

2. Physiological stress 

Stress factors can include major surgery, severe trauma, high fever, and haemorrhage (bleeding).¹

3. Medical conditions 

If a person suffers from conditions such as hyper- or hypothyroidism, hepatic (liver) failure, chronic renal failure, inflammatory bowel disease, HIV, psoriasis or seborrheic dermatitis, then they are at higher risk of suffering from telogen effluvium.²

4. Dietary triggers

Low protein intake, iron and zinc deficiency, and crash dieting can increase the chances of hair shedding in telogen effluvium.¹

5. Ultraviolet light 

Exposure of the hair to sunlight reveals alterations in the cellular components and damage to the hair cuticle and cortex, which shows that UV light can cause shedding of hair.²

Symptoms of telogen effluvium

If the hair shedding lasts for less than six months, it is called acute telogen effluvium whereas if it lasts more than six months, it is considered chronic telogen effluvium.²

The symptoms of telogen effluvium include–

• Increase in the amount of hair shedding, which can be noticed on the hairbrushes, in shower drains, or on pillows.⁴
• Thinning hair on the scalp and dry hairs that fall out easily (Alopecia UK)
• There should not be any symptoms such as a rash, itching, burning, pain, or flaking.¹
• Trichodynia can cause issues such as tenderness, pain, burning, itching, stinging, and diffuse alopecia.²

Diagnosis of telogen effluvium

Telogen effluvium is a type of hair loss that is often diagnosed through a combination of methods. These methods typically include–

1. Medical History

The first step in diagnosing telogen effluvium is taking a thorough medical history, including recent illness, surgery, childbirth, stressors, and medication or dietary changes. This information can help identify potential triggers for hair loss.¹

2. Physical Examination

A physical examination of your scalp and hair is carried out to check for signs of inflammation, infection, or other scalp conditions that might be contributing to hair loss.¹

3. Laboratory Tests

In some cases, laboratory tests may be ordered to rule out underlying medical conditions or to confirm the diagnosis of telogen effluvium. Blood tests can help identify conditions like iron deficiency anaemia, thyroid disorders, or hormonal imbalances that may be contributing to hair loss. A hair pull test may also be performed, where a small number of hairs are gently pulled to assess how many are in the telogen (resting) phase of the hair growth cycle.¹

4. Trichrogram

In this test, a small sample of hair is plucked from the scalp and analyzed under a microscope. This can help determine the percentage of hairs in the telogen phase. In telogen effluvium, a higher percentage of hairs will be in the telogen phase than in the anagen (growth) phase.⁵

5. Videodermoscopy

This technique allows for magnified visualization of the scalp and hair, which can reveal specific patterns or signs associated with different types of hair loss, including telogen effluvium. Trichoscopy can help differentiate telogen effluvium from other conditions like androgenetic alopecia (male or female pattern baldness).⁵

6. Scalp biopsy

During a scalp biopsy, a small piece of skin from the scalp is removed and examined under a microscope. This can provide information about the condition of the hair follicles and the presence of inflammation or scarring, which can aid in the diagnosis of telogen effluvium. This test also helps in ruling out other scalp conditions and differentiating against androgenic alopecia.⁶

Treatment of telogen effluvium

Telogen effluvium is usually temporary and reversible, and there are several treatment options available to help manage and address this condition.

1. Identify and address underlying causes

The first step is to identify and address any underlying causes through a medical evaluation, which can determine if a medical condition is contributing to hair loss. For example, if a hormonal imbalance is suspected, medications specific to that may be recommended.¹

2. A balanced diet 

   Proper nutrition and stable body weight are essential for healthy hair growth. A well-balanced diet rich in vitamins, minerals, and proteins is important. Some supplements, such as biotin, iron, and zinc, may be recommended if deficiencies are detected.²

3. Topical treatments

   Topical treatments, such as minoxidil, can be applied directly to the scalp. While minoxidil is FDA-approved for androgenetic alopecia (male and female pattern baldness), it can be used in the case of telogen effluvium to potentially promote hair regrowth because of its ability to extend the anagen phase.⁶

4. Patient education

Stress is a major cause of hair loss diseases. Psychological counselling is considered the best option to address emotional or psychological issues.⁶

Summary

Telogen effluvium is a form of non-scarring alopecia which can be identified by excessive hair shedding, typically resulting in hair thinning and a noticeable increase in hair loss. This condition occurs when a significant number of hair follicles prematurely enter the telogen, or resting phase of the hair growth cycle, leading to the shedding of hairs. Several factors can trigger telogen effluvium, which includes illness, surgery, childbirth, rapid weight loss, certain medications, nutritional deficiencies, and hormonal imbalances.¹

The symptoms of telogen effluvium typically manifest as increased hair loss when brushing or washing the hair. This can result in a diffuse thinning of hair on the scalp. Risk factors for developing telogen effluvium include a history of stress, recent significant life events, certain medical conditions, and medication usage.²

Diagnosis often involves a comprehensive evaluation of the patient's medical history, a physical examination, and sometimes blood tests to rule out underlying medical conditions. Treatment strategies focus on addressing the root cause and may include stress management, dietary adjustments, discontinuation of triggering medications, or specific treatments to correct hormonal imbalances. With proper diagnosis and targeted intervention, individuals experiencing telogen effluvium can often regain their hair's normal growth cycle and volume.¹

FAQ

How long does telogen effluvium last?

Telogen effluvium is a temporary hair loss condition. It typically lasts around 3-6 months but can extend to a year in some cases. It is often triggered by stress, illness, or hormonal changes, and most people see their hair return to normal once the underlying cause is addressed.

Where do you lose the most hair with telogen effluvium?

In telogen effluvium, hair loss primarily occurs from the scalp. This condition disrupts the hair growth cycle, pushing more hair follicles into the resting (telogen) phase. As a result, excessive shedding leads to noticeable thinning and loss of hair from the scalp, often evenly distributed.

Does hair grow back after telogen effluvium?

Yes, hair typically regrows after telogen effluvium, a temporary hair-shedding condition caused by stress, illness, or hormonal changes. Once the underlying trigger is resolved, most people experience gradual hair regrowth within a few months to a year, though individual recovery times may vary.